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Suicide rates across the nation have been continually rising at an alarming rate. According to the Centers for Disease Control and Prevention, roughly 47,000 Americans died by suicide in 2017. What is less known, however, is that the elderly living in long-term care facilities are particularly prone to suicidal ideations and attempts. The rate of suicide among the elderly has skyrocketed to the point that other institutions have taken notice and made an effort to further research the issue.

According to University of Michigan researchers, roughly one long-term care resident dies by suicide every day. While this number is distressingly high, researchers estimate it is likely much higher, as accurate records are not always kept regarding suicides in nursing homes and other assisted living facilities. To make matters worse, one-third of all long-term care residents have reported thoughts of suicide, which heightens their risk of succumbing to this tragedy.

In fact, between 2003 and 2015, University of Michigan researchers found that of all the suicides committed by those 55 years or older, 2.2% were directly related to long-term care.

Falls are an incredibly common cause of serious injury, particularly in the older generation. In fact, more than one out of every four individuals 65 or older falls every year according to the Centers for Disease Control and Prevention. For those who are frail, infirm or unstable, the results can be devastating, and sadly, statistics show that someone who has fallen once is twice as likely to fall again.

What Are Common Fall-Induced Injuries?

Fatal falls have increased 30% between 2007 and 2016 according to the CDC. In 2016, 29,668 individuals 65 and older died as a result of a fall, compared with 18,334 in 2007. Furthermore, over 800,000 are hospitalized each year, and nearly 3 million people present to the Emergency Department annually on account of a fall. Head injuries, hip fractures and traumatic brain injuries are some of the most common serious injuries sustained by fall victims.

On March 6, 2019, the U.S. Senate Committee on Finance gathered for a hearing to discuss cases of nursing home abuse and neglect that have plagued residents throughout the nation. Predominantly, the hearing shed light on the lack of preventive measures The Centers for Medicare and Medicaid Services have in place to protect residents from abuse and neglect. Chairman Chuck Grassley (R-IA) led the hearing along with Ranking Member Ron Wyden (D-OR).

During the hearing, several family members of abused and neglected residents shared testimonies about the harm and suffering their loved ones endured as a result of the grossly substandard care provided. One Minnesota woman recalled her mother’s rape by a nursing home caregiver, which left her mother crying and hitting her private parts for days, unable to communicate what happened. “We assured my mother that she would be safe: she would not suffer. I can never overcome the guilt of realizing that these promises were not kept: She was not safe, she was raped,” the daughter shared.

A woman from Iowa detailed her mother’s death while in a nursing home facility that had been given the highest rankings in quality measures by CMS. According to testimony, her mother was transferred to a hospital where she was found to be extremely dehydrated. The emergency room doctor stated the woman had not been given fluids in the last four to five days and said he planned on reporting the abuse. The woman passed away shortly after.

Tennessee Health Management, Inc. Pays $9.7 Million for Fraudulent Claims

In early February, U.S. Attorney for the Middle District of Tennessee, Don Cochran, announced Tennessee Health Management, Inc. would pay $9.7 million after allegedly submitting false claims to Tennessee’s Medicaid program, TennCare.

The management company owns 27 skilled nursing facilities in Tennessee, including three in Memphis and one in Cordova.

The opioid epidemic is not limited to any one age group, region or ethnicity. It is pervasive throughout the country and affects even the elderly in nursing homes and long-term care facilities.

According to The Centers for Medicare and Medicaid Services, 40 percent of all opioid overdose deaths involve a prescription opioid, and the drugs were responsible for more than 42,000 deaths in 2016 alone. As such, CMS has been striving to limit the number of prescribed opioids in the U.S. by encouraging doctors to prescribe such drugs only when the benefits outweigh the risks and by promoting the use of non-opioid pain treatments.

Over-Prescribing Opioids

All long-term care residents are at a risk for wandering. However, those with diseases that diminish cognitive abilities, such as dementia or Alzheimer’s, are more likely to wander or elope. In the most dangerous cases, elopement has led to serious injury and death.

While statistics vary on how frequently patients wander, one 2006 study found that at least one in five residents with dementia will wander at least once. The National Council of Certified Dementia Practitioners shared one case study in which a cognitively impaired woman wandered to the facility’s roof. No one noticed her absence for several hours. After a search was initiated, she was found suffering from severe hypothermia and passed away shortly after in the hospital.

This has significant implications for nursing home staff. Residents with dementia require extensive supervision, as patient safety is the nursing home’s main priority. This also encourages family members to assess a facility’s ability to safely care for their loved one before admitting them to a nursing home.

Kaiser Health News, along with an analysis conducted by Definitive Healthcare, released statistics in September 2018 detailing the severity of sepsis infections among nursing home residents. Approximately 25,000 nursing home patients are transferred to hospitals annually due to sepsis. Treatments for the infection are not cheap or quick — Medicare spends roughly $2 billion each year caring for sepsis sufferers.

In fact, sepsis was found as the leading cause of transfers from nursing homes to hospitals. Sadly, these cases lead to death “much more often” than other medical conditions, and the elderly pose an additional risk of getting the disease due to weaker immune systems.

Knowing the symptoms of sepsis and early detection are both key in preventing further, incurable damage to a loved one’s health.

Medicare has taken an aim to reward nursing homes based on their quality of care rather than quantity, and to penalize the homes that fall short. The recently implemented Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) will redistribute funds to 14,959 skilled nursing facilities across the nation, based on how many nursing home residents are readmitted to a hospital within 30 days of discharge. While the SNF VBP financially encourages quality care, there is concern that nursing homes are now more reluctant to send ill patients to the hospital in order to dodge penalization.

According to CMS data analyzed by Modern Healthcare, approximately 73% of skilled nursing facilities were financially penalized in 2018, while a mere 27% received bonuses.

A nursing home may receive a deduction in funds as severe as 2%, and a bonus as high as 1.6% in Medicare Part A payments. Nearly 20% of skilled facilities received the maximum 2% pay cut, and only 3% of facilities received the full 1.6% bonus.

Nearly every major news outlet across the nation has been following the story of a 29-year-old Arizona nursing home resident that gave birth to a baby boy at the end of December while in a vegetative state. The disturbing facts of the case continue to shed light on the internal problems of nursing homes, the horrors of sexual assault and the prevalence of caretaker abuse and neglect.

Facts of The Case

On December 29, paramedics were dispatched to Hacienda HealthCare after receiving a 911 call from a nurse stating, “The baby’s turning blue!” Later in the phone call, the nurse told the dispatcher, “We had no idea she was pregnant.”

With the Me Too movement in full swing, more and more victims of sexual abuse are finding their voices and gaining the courage to speak out against assailants. The group that is perhaps the least empowered by the new campaign is the elderly. While sexual assault runs rampant throughout nursing homes and long-term care facilities, many times, the abuse goes unreported.

Sexual Abuse: A Frequent Evil in Nursing Homes

A February 2017 CNN report detailed just how serious the problem is. Since 2000, over 16,000 complaints of sexual abuse in nursing homes and assisted living facilities have been reported. While that number appears high, officials warn that the true figure of actual assaults is likely much higher. The reported 16,000 only accounts for cases that have been looked into and resolved by state long-term care ombudsmen; it does not account for other allegations.